AMI로 SES 혹은 PES 시술을 시행받은 모든 환자에서 4년 이상의 임상추적 기간이 지난 환자를 대상으로 데이터를 분석하여 두 스텐트의 안전성과 유용성을 비교해 보고자 하였다. 2004년 1월 1일부터 2006년 8월 31일까지 본원에서 ST분절 상승 혹은 ST 분절 비상승 급성심근경색증 (STEMI or NSTEMI)로 진단되어 입원 기간 중 관동맥중재술을 시행받은 환자 중 SES 혹은 PES 삽입술이 시행된 환자를 대상으로 후향적 분석을 시행하였다. 그리고 사망, 심장사. 심근경색증, 표적 혈관재관류술, 스텐트 혈전증 발생에 대해 분석하였다. 연구 기간 동안 총 668명의 급성심근경색증 환자가 중 522명만 연구 대상에 포함 사망 ($18.3{pm}3.0%$ vs. $14.6{pm}2.2%$, p=0.26), 심장사($11.2{pm}2.6%$ vs. $6.8{pm}1.52%$, p=0.39), 심근경색증 ($6.4{pm}1.8%$ vs. $3.3{pm}1.1%$, p=0.31), and 스텐트 혈전증 ($5.4{pm}1.7%$ vs. $3.2{pm}1.1%$, p=0.53) 표적 혈관재관류술(TVR) ($10.0{pm}3.0%$ vs. $4.0{pm}1.2%$, p=0.008) and 심혈관계 임상사건(MACE) ($29.4{pm}3.5%$ vs. $19.4{pm}2.5%$, p=0.003) 급성심근경색증의 초기 치료에 약물방출스텐트인 SES와 PES의 4년 장기 임상 성적을 조사한 본 연구를 통해 전체환자를 대상으로 분석하였을 때 두 스텐트의 장기 사망률, 심장사. 심근경색증, 표적 혈관재관류술, 스텐트 혈전증의 발생은 차이가 없었으나 TVR 및 MACE의 발생은 PES 삽입 환자가 SES삽입 환자보다 유의하게 높았다.
There is a still unsettled issue about the comparison of long-term clinical effects between sirolimus-(SES) and paclitaxel-eluting stents (PES) for the patients with acute myocardial infarction (AMI). Therefore, we performed a retrospective analysis to evaluate the 4-year clinical outcome of SES as compared with PES after percutaneous coronary intervention (PCI) in patients with AMI. From January 2004 to August 2006, all consecutive patients with acute ST-segment elevation myocardial infarction (STEMI) underwent primary PCI and acute NSTEMI underwent PCI by implantation either SES or PES were enrolled. The occurrence of death, cardiac death, recurrent infarction, target vessel revascularization (TVR) and stent thrombosis were analyzed. The composite of major adverse cardiac events (MACE; death, recurrent infarction and TVR) were also analyzed. During the study period, total 668 AMI patients had visited. Of them, total 522 patients (299 with SES and 223 with PES) were enrolled. During 4-year clinical follow-up, there were similar occurrences of death ($18.3{pm}3.0%$ vs. $14.6{pm}2.2%$, p=0.26), cardiac death ($11.2{pm}2.6%$ vs. $6.8{pm}1.52%$, p=0.39), re-infarction ($6.4{pm}1.8%$ vs. $3.3{pm}1.1%$, p=0.31), and stent thrombosis ($5.4{pm}1.7%$ vs. $3.2{pm}1.1%$, p=0.53) between the two groups, consecutively. The occurrences of TVR ($10.0{pm}3.0%$ vs. $4.0{pm}1.2%$, p=0.008) and MACE ($29.4{pm}3.5%$ vs. $19.4{pm}2.5%$, p=0.003) were significantly higher in patients treated with PES than SES. In AMI patients treated with either SES or PES implantation, SES had a significantly lower risk of TVR and MACE during 4-year clinical follow-up. Rates of death, cardiac death or recurrent infarction, and stent thrombosis were similar.
